HomeMy WebLinkAbout919 BITTERBRUSH LN - APPLICATIONS - 3/9/2015From Affordable Roofing Inc 1.970.207.0289 Mon Mar 9 16:50:15 2015 MDT Page 2 of 2
IFS/ 0-IF
,,-br?. C® AO-ns
Planning, Developmeni & T ransoortatian
281 N. College Ave P:O. Box 58G
Fort Collins, CO 80524
Phone 970-416-2:790 Fax 22 -6134
O1 iawwRm 'Ea'®U"7 @ E03 G EiB11 OS" 010,1111.
This application is to be used to apply for the following permits only (check all that apply). 11 Air Conditioning
❑ Demolition ;inter far non-structural) ❑ Electrical Alteration (not service change) O Gas lighter U Gas Loa
O _eating Unit U Lawn Sprinkler U Mobile Home replacement ❑ P,00fing ❑Sewer Line U Phato e'o}taic
U Varbiation Q Viattar Hem er ❑ Water Line Ci Wood/Pellet Sicva (must be EPA certified, orovide make, model and
manufacturer).
Curnplete all applicable information on the application. Incomplete applications will not be accepted.
?rIicaTionF?1 $0144��
i'Or Off ce U_`e only
Date
.-..
+ob Site Address (reQafr1c"D)
�= tc(brvsh Lam....
atilC OT COr{5'LrUC'YIOi1 materials, rials,
a_ooa
,�rg"ili)
?rot : Owner Name
Address
Cii ,15tate Zip
_
Phone,.
p EiC�:nt l�am2
address
City/Stage Zip
shone '970
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2
Contractor J
i
Address
Q'i-JI/State 7
-Ic
Phone
Contractor Ciy of Fr. Collins Sales Tax
' c_r@_ca.Y lltlrl7�?r is r&?uiredbl rap ContFamr-,'.
Are 8 you ' , y p) ing with your trust account: Yes
(] No
.c> "h a tcsloermal Or Cammefclal project? ,R- Residential U Cemmerciai
Tf reas-lde:n;ia'l, is it: Est Singe Family D;,tached ❑ Condo/ta.vnhome (single family at-muhed) ❑ Duplex
C Multil:amIlY (apartment) U Garage
3f cglnrierc;ai, Is fc: 0 Bank U` Bar ❑ Church ❑ Hotel; Motel O ,vledical office C1 Office ❑ Retail
J P,est'aurant Cl Other (explain)
is this building 50 years of age or more? oyes O No f^ yes, rou may need to contact HiStorC Prese�rai?vn if tNs IS fOr a demolition permit, whatyear was the building conscrected?
f pyor to 1973, You will need an asoesrus assessment~ to submi= with Gyis aopiicdaon.
of Work
,awn :?rinf(ler%baCkrl04V preventer, must 11S-y ticansed plumber. if rj,-t-time A/C, must GsL licensed electrician.
ubconCrarLors:�ts rh_=comcL=nynamcorCiryoff?Collinslrcen��='
Plumber_____ techanical lydrjC
I hereby acknowledge that r have read this appl;cation and state that the above information is complete and correct, I agree o . , con aly ':Vain all requirements contained herein and city ordinances and state laws regulating building construction, 1 know that a
D,-rmis is no: valid until it has been paid and issued,
Print Name:-_t t r� N-l._�